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Nurses Have an Amazing Capacity to Do More

By Marie Manthey FAAN, MNA, FRCN, PhD, (hon) President Emeritus, Creative Health Care Management

I know if I said “Nurses have an amazing capacity to do more” in a speech before an audience of nurses many would get angry, and some would probably walk out. And yet, it is something that I believe to be true. Not for all nurses, not in all work situations, not all the time, but something we would be foolish to deny.

Over my many years in the profession, I have seen the restraints that handicap our role expansion and have envisioned the contribution nurses could make to the healthcare of society if those restraints were removed. The realities I call restraints are both internal and external. Some are imposed by regulations designed to protect the job security of others, as well as the job security of nurses. Some are in place because of historical precedents not yet dissolved—precedents like inadequate education, cost constraints, physician-nurses role delineations disputes, and the sexual discrimination still somewhat prevalent in today's society. Some of these are so big, and are kept in place by such powerful forces, they seem insurmountable.

Others are restraints of our own making.

These include a pervasive reluctance/fear to accept responsibility for ourselves, our practice, and our interpersonal relationships. They include a "within the profession" reluctance to assert the right of control over nursing practice by virtue of our license. They include a willingness to work in environments that are dysfunctional without either fixing the problem or leaving the work setting. They include an incredible tolerance for ongoing “within the profession” disputes about solvable problems like entry level educational standards and proper utilization of support staff. An enormous amount of energy is dissipated at the highest levels of professional development on issues that require strategic and tactical decision making among various interest groups within the profession. Decisive action in these areas, while probably not agreed to universally, would still have the power to restore energy to more productive uses.

What do I envision?

  1. When problems are easy to solve, let’s solve them. For example, the lack of continuity at the system level that patients suffer from could be solved by developing procedures for call-backs to patients’ homes. Not all patients, not all the time, but a responsible nurse can decide whether to do so or not.
  2. A role for RNs that includes time for "'looking at the big picture" and exercising real coordination/cooperation among specialties in highly complex situations. This can be done by providing appropriate technical support staff.
  3. Nurses partnering with physicians (or other primary providers) and collaborating in decision making, along with empowering patients to participate in and ultimately own their own healthcare decisions.
  4. Nurses creating support structures for non-nurse care providers that both educate them in the techniques of patient care and also support them emotionally.

We are so bogged down in task performance, so diminished by our lack of self-worth, and so willing to abdicate responsibility for what we are licensed to do that we haven't taken the time to lift our eyes, envision a new future, and learn how to play together to create a world where nurses are having a major impact on the health of society and are manifesting health lives ourselves.

Accepting responsibility for our own destiny as nurses creates consciousness of choice. Until we embrace the reality of our own ability to make choices and accept and learn from consequences, nursing will forever be a dependent profession. I am gratified when I see trends in nursing education that embrace the ideas of personal empowerment and professional partnerships for effective collaboration. It is possible that the tide is turning. The good news is that it is you who can turn the tide.

Saying Marie has seen it all is either literally true or an understatement. The founder and president emeritus of Creative Health Care Management, Marie has been a nurse since, she says, “practically age five.” And through that time, she’s been motivated by the same burning passion: focus on the nurse-patient relationship and its potential for healing.

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